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Junjiro Kobayashi

Publications and source records attributed to Junjiro Kobayashi.

53 records · Page 3Linked to original sources
PubMed2003

Implantation of collar-reinforced sumit valve for patient with large calcified mass obstructing the mitral valve orifice.

A 56-year-old female had a severely calcified mitral valve annulus and a huge subvalvular mass. To avoid critical damages of the coronary artery and left ventricle, the annular calcification and the part of the mass adherent to the left ventricle were not resected. Then we performed mitral valve replacement using SuMit valve and collared reinforcement technique with xenopericardium without any major complications. The SuMit valve is designed to be placed in a supraannular position, and is useful to prevent valves from getting stuck.

Calcinosis↗
PubMed2003

Early results of complete off-pump coronary revascularization using left internal thoracic artery with composite radial artery.

OBJECTIVE: Off-pump coronary artery bypass (OPCAB) using the left internal thoracic artery (LITA) with a composite radial artery (RA) was employed for arterial revascularization in order to minimize neurological complication. METHODS: Sixty-one patients underwent OPCAB using the LITA with a composite RA. Angiography was performed in all patients at two weeks postoperatively. RESULTS: The mean number of distal anastomoses was 3.2 +/- 0.4. A Y-composite graft was used in 55 patients, and K-composite graft was used in the other 6 patients. There was no hospital death, no neurological complication nor deep sternal infection. Furthermore, there was no episode of perioperative myocardial infarction nor hypoperfusion syndrome. Patients have been angina-free during a mean follow-up period of 1 year. The graft patency of the LITA to the left anterior descending artery (LAD) was 100% (61/61 anastomoses). The RA became occluded in 4 patients, and the patency rate was 95.6% (130/136 anastomoses). String or coronary-coronary bypass resulting from flow competition was observed in the LITA of 6 patients and in the RA of 13 patients. The string of the LITA occurred in the segment distal from the anastomosis with the composite RA. The string or coronary-coronary bypass was observed more often in cases in which the recipient coronary artery had less than 75% stenosis. CONCLUSION: OPCAB using only the LITA with a composite RA can be successfully and safely performed in patients with multivessel disease. Late postoperative follow-up of the flow competition is necessary to delineate the significance of flow competition.

Aged↗
PubMed2003

Durability and outcome of aortic valve replacement with mitral valve repair versus double valve replacement.

BACKGROUND: The purpose of this study was to evaluate morbidity and mortality after double valve replacement (DVR) and aortic valve replacement with mitral valve repair (AVR + MVP). METHODS: From 1977 to 2000, 379 patients underwent DVR (n = 299) or AVR + MVP (n = 80). Actuarial survival and freedom from reoperation were determined by the Kaplan-Meier method. Potential predictors of mortality and reoperation were entered into a Cox multiple regression model. Propensity score was introduced for the multivariable regression modeling for adjustment of a selection bias. RESULTS: Survival 15 years after surgery was similar between the groups (DVR, 81% +/- 3%; AVR + MVP, 79% +/- 7%; p = 0.44). Freedom from thromboembolic event at 15 years was similar between the groups (p = 0.25). Freedom from mitral valve reoperation at 15 years was significantly better for the DVR group (54% +/- 5%) as compared with the AVR + MVP group (15% +/- 6%; p = 0.0006), primarily due to progression of mitral valve pathology and early structural deterioration of bioprosthetic aortic valve used for patients with AVR + MVP. After AVR + MVP, freedom from mitral reoperation at 15 years was 63% +/- 16% for nonrheumatic heart diseases, and 5% +/- 5% for rheumatic disease (p = 0.04). CONCLUSIONS: Although both DVR and AVR + MVP provided excellent survival, DVR with mechanical valves should be the procedure of choice for the majority of patients because of lower incidence of valve failure and similar rate of thromboembolic complications compared with AVR + MVP. MVP should not be performed in patients with rheumatic disease because of higher incidence of late failure.

Actuarial Analysis↗
PubMed2003

Early and late stroke after mitral valve replacement with a mechanical prosthesis: risk factor analysis of a 24-year experience.

OBJECTIVE: We evaluated risk factors for mortality and stroke after mechanical mitral valve replacement between May 1977 and December 2001. METHODS: Early and late mortality and stroke were assessed. Potential predictors of mortality and stroke were entered into a Cox proportional hazards model. Actuarial survival and freedom from stroke were determined by a log-rank test. RESULTS: Mitral valve replacement was performed in 812 patients. Concomitant procedures included left atrial appendage closure in 493 (61%) patients, tricuspid annuloplasty-replacement in 348 (43%) patients, maze procedure in 185 (23%) patients, plication of the left atrium in 148 (18%) patients, and other procedures in 151 (19%) patients. Five-year actuarial survival was 91.1% +/- 2.3%. Freedom from stroke at 8 years was significantly better in patients with sinus rhythm versus atrial fibrillation (P <.001). Ninety-nine percent of patients with mitral valve replacement combined with a maze procedure were free from stroke, whereas only 89% of patients with mitral valve replacement alone were free from stroke at 8 years after surgical intervention. Seventy-two patients had late stroke; sixty-five patients (90%) were in atrial fibrillation, and 47 (65%) patients had the left atrial appendage closed. Multivariate analysis showed that late atrial fibrillation (odds ratio, 3.39; 95% confidence interval, 1.72-6.67; P =.0001) and omission of the maze procedure (odds ratio, 3.40; 95% confidence interval, 1.14-10.14; P =.003) were the significant risk factors for late stroke. CONCLUSIONS: Persistent atrial fibrillation was the most significant risk factor for late stroke after mechanical mitral valve replacement. Restoration of sinus rhythm with a maze procedure nearly eliminated the risk of late stroke, whereas neither closure of the left atrial appendage nor therapeutic anticoagulation prevented this complication.

Adolescent↗
PubMed2003

Early adaptation of the left internal thoracic artery as a blood source of y-composite radial artery grafts in off-pump coronary artery bypass grafting.

OBJECTIVE: Y-composite grafting with the radial artery (RA) is often used in off-pump coronary artery bypass grafting (OPCAB). However, the early flow reserve of the left internal thoracic artery (LITA) as a blood source of the Y-composite RA graft has not been delineated. METHODS: The size of the LITA was examined angiographically in 42 patients who underwent OPCAB using LITA and Y-composite RA grafting between June 2000 and February 2002. In these patients, the LITA was used as a blood source of the Y-composite RA graft. The mean patient age +/- SD was 67 +/- 8 years. The average number of d i stal anastomoses was 3.2 +/- 0.7. Total coronary revascularization was carried out in 34 patients with only LITA and Y-composite RA grafting. RA grafting was used for revascularization of the circumflex artery alone in 5 patients, for the right coronary artery system (RCS) alone in 6 patients, and for both the circumflex and the RCS in 23 patients. The average number of distal anastomoses using the RA was 1.9 +/- 0.7. Flow measurements of the proximal LITA were achieved intraoperatively with a transit-time flowmeter. The diameters of the LITA before and after the operation were measured angiographically. Intraoperative flow volume was correlated with the ratio of the LITA diameters before and after the operation. RESULTS: The mean flow rate of the LITA was 61 +/- 35 mL/min (range, 9-196 mL/min). The mean diameters of the LITA before and after the operation were 1.97 +/- 0.36 mm and 2.74 +/- 0.60 mm, respectively. The mean ratio of the LITA diameter after the opera t ion to that before the operation was 1.43 +/- 0.27. The intraoperative flow volume was positively correlated with the ratio of LITA diameters (r = 0.414; P =.006). CONCLUSION: These results demonstrate the early adaptation of the LITA as a blood source of the Y-composite RA graft in OPCAB and the rationale for using the LITA as a single blood source for total coronary artery revascularization.

Aged↗
PubMed2002

The effect of cryo-maze procedure on early and intermediate term outcome in mitral valve disease: case matched study.

BACKGROUND: The maze procedure is an effective way to treat atrial fibrillation (AF) associated with mitral valve disease. In a last several years, cryoablation was substituted for atrial incision in many reports to simplify the maze procedure. However, there has been no comparative study to delineate the feasibility of the use of cryoablation. METHODS AND RESULTS: We compared the early and intermediate-term results of the maze procedure including pulmonary venous isolation from the left atrium using cryoablation (CM) with our conventional (Kosakai) maze procedure (KM) including encircling incision around the orifices of pulmonary veins. One hundred and 10 pairs of patients were matched in the age, left atrial dimension >70 mm, duration of AF >0 years, previous cardiac surgery, mechanical valve implantation and concomitant aortic valve procedures. CM required significantly shorter cardiopulmonary bypass time (186+/-56 minute versus 214+/-47 minute, P=0.001) and aortic cross-clamp time (134+/-43 minute versus 144+/-37 minute, P=0.03) than KM with less chest tube drainage (590+/-353 mL versus 745+/-618 mL, P=0.02) for 12 hours after operation. The sinus rhythm restoration rate in CM group (85.4%) was comparable with KM group (86.4%) at discharge. In the late results, the actuarial freedom from recurrence of sustained AF at 3 years in CM group (97.7%) was not significantly (P=0.11) different from that in KM group (90.4%). The actuarial freedom from stroke at 3 years in CM group was 99.0%. CONCLUSION: The modification of the maze procedure including cryoablation for pulmonary venous isolation provided less aortic cross-clamp time and less amount of chest tube drainage with the comparable recovery and maintenance of sinus rhythm with KM. CM is a reliable and less invasive surgical option for the AF associated with mitral valve disease.

Atrial Fibrillation↗
PubMed2002

The impact of diabetic retinopathy on long-term outcome following coronary artery bypass graft surgery.

OBJECTIVES: We sought to assess the impact of diabetic retinopathy on long-term outcome among patients with diabetes and multivessel coronary artery disease (MVD) following coronary artery bypass graft surgery (CABG). BACKGROUND: For diabetics, CABG is the preferred revascularization strategy. Diabetic retinopathy is a major microvascular complication of diabetes, and its severity is directly related to total glycemic exposure. METHODS: We identified 223 consecutive diabetics with MVD whose retinae were evaluated within one year prior to CABG. The most recent ophthalmologic records up until the time of CABG were used to evaluate the severity of retinopathy. The median follow-up after CABG was 11.6 years. RESULTS: Diabetic retinopathy was a strong independent predictor of overall mortality (relative risk [RR], 4.0), and repeat revascularization (RR, 3.0). In separate analyses of diabetics with retinopathy and without retinopathy, predictors of mortality differed significantly between the two groups. Among diabetics with retinopathy, the presence of either preoperative renal (RR, 2.5) or ventricular (RR, 2.0) dysfunction had unfavorable effects on mortality, but the survival curves did not differ significantly according to the presence or absence of internal thoracic artery (ITA) grafting. In comparison, among diabetics without retinopathy, ITA grafting (RR, 0.34) had a beneficial effect on mortality, and the survival curves varied somewhat according to the presence or absence of renal or ventricular dysfunction. CONCLUSIONS: Diabetics with retinopathy had a distinct post-CABG course with a worse long-term prognosis, as compared with diabetics without retinopathy. Retina evaluation is useful for prediction of long-term prognosis and management of diabetics who need CABG.

Aged↗
PubMed2002

The electrophysiologic mechanism of ST-segment elevation in Brugada syndrome.

OBJECTIVES: We sought to demonstrate the electrophysiologic (EP) mechanism of the ST-T change in Brugada syndrome. BACKGROUND: Brugada syndrome is characterized by various electrocardiographic manifestations (e.g., right bundle branch block, ST-segment elevation, and terminal T-wave inversion in the right precordial leads) and sudden cardiac death caused by ventricular fibrillation. Direct evidence in support of the EP mechanism underlying this intriguing syndrome has been lacking. METHODS: Monophasic action potentials (MAPs) were obtained from three patients with the coved-type ST-segment elevation (Brugada patients) and five control patients using the contact electrode method. Epicardial MAPs were recorded during open-chest surgery in all patients. RESULTS: A spike-and-dome configuration was documented from epicardial sites of the right ventricular (RV) outflow tract in all Brugada patients but not in control patients. Monophasic action potential recordings from the endocardium with special focus on the RV outflow tract could not demonstrate any morphological abnormalities in three Brugada patients. CONCLUSIONS: The presence of a deeply notched action potential in the RV epicardium, but not in endocardium, would be expected to induce a transmural current that would contribute to elevation of the ST-segment in the right precordial leads. The spike-and-dome configuration may also prolong the epicardial action potential, thus contributing to a rapid reversal of the transmural gradients and inscription of an inverted T-wave.

Aged↗
PubMed2002

Plasma atrial natriuretic peptide concentration inversely correlates with left atrial collagen volume fraction in patients with atrial fibrillation: plasma ANP as a possible biochemical marker to predict the outcome of the maze procedure.

OBJECTIVES: We hypothesized that the plasma atrial natriuretic peptide (ANP) level reflects atrial degenerative change and may predict the outcome of the maze procedure. BACKGROUND: Although a larger preoperative left atrial dimension and longer duration of atrial fibrillation (AF) have been reported in patients with persistent AF than in those with sinus rhythm (SR), these individual factors were not enough to predict the outcome of the maze procedure. METHODS: Preoperative plasma ANP levels were measured in consecutive 62 patients who underwent the Kosakai's modified maze procedure. Moreover, we performed histological and molecular biological examinations in the resected left atrial tissues. RESULTS: The preoperative plasma ANP was lower in the AF group (n = 13) than it was in the SR group (n = 49) (p < 0.001). Multiple logistic regression analysis revealed that duration of AF and plasma ANP were independently associated with postoperative cardiac rhythm. Among 41 patients with a higher plasma ANP or shorter duration of AF than the median value, SR was restored in 95% of patients. In contrast, in 21 patients with a lower plasma ANP and a longer duration of AF than the median value, SR was restored only in 48% of patients. Histological examination revealed that the collagen volume in the left atrial tissue was higher in AF than it was in SR and inversely correlated with plasma ANP. In addition, the messenger RNA expressions of ANP, collagen type I and type III were lower in AF than they were in SR. CONCLUSIONS: These results suggest that a combination of plasma ANP and/or duration of AF may predict the success rate for the maze operation. Advanced atrial degenerative change may result in a decrease of atrial ANP secretion.

Aged↗
PubMed2002

Maze procedure and cor triatriatum repair.

A 39-year-old man had cor triatriatum (Lucas-Schmidt type IA) with severe mitral regurgitation and atrial fibrillation. We performed resection of the anomalous septum between the accessory chamber and the left atrium, and conducted mitral valve repair and the maze procedure. The patient regained sinus rhythm and normal pulmonary venous drainage to the left ventricle without mitral regurgitation. Histological examination demonstrated fibrotic myocardial structures in the anomalous septum. The maze procedure and complete excision of the anomalous septum proved to be effective surgical treatment for atrial fibrillation with cor triatriatum.

Adult↗
PubMed2002

Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease.

OBJECTIVE: We sought to determine whether the Cox maze procedure provides additional benefit to patients with atrial fibrillation undergoing mitral valve operations. METHODS: Between May 1992 and August 2000, we performed 258 Cox maze procedures with mitral valve replacement (n = 147) or mitral valve repair (n = 111). We compared the outcomes of these patients with those of 61 control patients with preoperative atrial fibrillation who underwent mitral valve replacement alone during the same interval. The three cohorts were similar in age, sex, and proportion of patients in preoperative New York Heart Association functional class 3 or 4. RESULTS: Although 5-year survivals were similar among the groups (94% for mitral valve replacement alone, 95% for mitral valve replacement plus maze, and 97% for mitral valve repair plus maze), freedoms from atrial fibrillation at 5 years were significantly higher in the mitral valve replacement plus maze group (78%) and the mitral valve repair plus maze group (81%) than in the mitral valve replacement group (6%, P <.0001). Freedoms from stroke at 5 years were 97% for the mitral valve replacement plus maze group, 97% for the mitral valve repair plus maze group, and only 79% for mitral valve replacement group (P <.0001). Multivariable analysis with Cox hazard model revealed that the most significant risk factor for late stroke was the omission of the Cox maze procedure (P =.003). CONCLUSIONS: The addition of the Cox maze procedure to mitral valve repair and replacement was safe and effective for selected patients. Elimination of atrial fibrillation significantly decreased the incidence of late stroke.

Aged↗
PubMed2002

Perioperative advantages of off-pump coronary artery bypass grafting.

For the first time in Japan, off-pump coronary artery bypass grafting (OPCAB) was compared with the conventional on-pump technique, retrospectively examining the morbidity associated with coronary artery bypass grafting (CABG) and assessing the efficacy of OPCAB. In 2000, 158 patients underwent CABG: 95 patients (60%) had OPCAB (Group I) and 63 patients (40%) had conventional CABG (Group II). The operating time, length of intensive care unit (ICU) stay, ventilation time, postoperative bleeding, transfusion, postoperative renal function, occurrence of stroke, and early graft patency were examined in both groups. There were no hospital deaths in either group. The operating time, ICU stay, and ventilation time were significantly (p < 0.0001, p = 0.013, and p < 0.0001, respectively) shorter in Group I (351 +/- 85 min, 3.0 +/- 1.4 days, and 5.1 +/- 2.8h) than in Group II (449 +/- 112 min, 3.6 +/- 1.8 days, and 13.7 +/- 18.0 h). The postoperative blood loss within 12h and the transfusion volume were significantly (p = 0.0004 and p < 0.0001, respectively) smaller in Group I (480 +/- 210 ml and 300 +/- 490ml) than in Group II (720 +/- 430ml and 1,230 +/- 1,180 ml). Peak serum blood urea nitrogen and creatinine concentrations (excluding patients with preoperative chronic renal failure, ie a preoperative serum creatinine > 1.5 mg/dl) were significantly (p < 0.0001 and p < 0.0001, respectively) lower in Group I (16.2 +/- 15.2mg/dl and 0.81 +/- 0.72 mg/dl) than in Group II (19.2 +/- 7.6 mg/dl and 0.92 +/- 0.28 mg/dl). There were no perioperative strokes in Group I, but 6.4% of Group II patients suffered a stroke. There was no significant difference in graft patency between the groups (95.6% vs 94.9%). OPCAB reduced the mortality and morbidity of coronary revascularization, with a shorter operating time and more rapid recovery from surgery.

Aged↗
PubMed2002

Total arterial off-pump coronary revascularization with only internal thoracic artery and composite radial artery grafts.

OBJECTIVE: Total arterial off-pump coronary artery bypass (OPCAB) grafting with only internal thoracic artery (ITA) and composite radial artery (RA) grafts has been applied extensively to avoid cerebral complications and late vein graft failure. We evaluated the initial experience with this method by clinical and angiographic study. METHODS: Between April 2000 and May 2002, 257 patients underwent OPCAB grafting with this technique. The range of ages at operation was 42 to 86 years (mean, 66.1 +/- 8.6 years). On average, 3.28 +/- 0.86 grafts per patient were completed. More than 4 distal anastomoses were performed in 88 patients (34%). For coronary revascularization, 289 ITA and 555 RA grafts were used. The RA was used as a Y graft in 211 patients, as an I graft (for ITA extension) in 52 patients, and as a K graft (the side of the RA attached to the side of the left ITA) in 28 patients. Sequential bypass grafting was performed with 190 RA and 7 ITA grafts. The sites of distal anastomoses were 256 left anterior descending arteries (30%), 236 posterolateral branches (28%), 144 posterior descending arteries (17%), 106 diagonal branches (13%), 82 obtuse marginal branches (10%), and 19 right coronary arteries (2%). RESULTS: There were 1 operative death (0.4%) due to cerebral hemorrhage and 2 episodes of stroke (0.8%) during postoperative angiography. There were no clinical underperfusion syndromes or new intra-aortic balloon pump insertions. Perioperative myocardial infarction occurred in 12 patients (4.7%), sternal dehiscence in 5 (1.9%), and early coronary intervention in 4 (1.6%). There was no deep wound infection, reexploration for bleeding, or hand ischemia. The actuarial survival rate and the cardiac event-free rate at 2 years were 98.6% +/- 2.4% and 94.2% +/- 0.8%, respectively. Early postoperative angiography revealed a 97.8% (264/270) graft patency of ITAs and 97.9% (512/523) graft patency of RAs in 238 patients. Flow competition of the RA graft was recognized in 22 patients and, as indicated by follow-up angiographic study, did not cause late graft occlusion. CONCLUSIONS: OPCAB grafting with ITAs and composite RAs provides excellent early and intermediate clinical results and graft patency.

Adult↗
PubMed2002

Eight-year experience of combined valve repair for mitral regurgitation and maze procedure.

BACKGROUND AND AIMS OF THE STUDY: Although atrial fibrillation (AF) is often associated with severe mitral regurgitation (MR), a simultaneous maze procedure for AF associated with repair of MR remains controversial. In this study, mid-term results of combined mitral valve repair and the maze procedure were examined. METHODS: Between May 1992 and April 2001, 85 patients (61 males, 24 females) underwent valve repair for MR and the maze procedure. Mean age at surgery was 61.8+/-9.1 years; mean follow up was 4.7+/-2.3 years. Valve lesions were anterior in 26 patients (31%), posterior in 31 (36%), anterior + posterior in 23 (27%), and simple dilated annulus in five (6%). Chordal replacement with expanded PTFE sutures was performed in 40 patients (47%), and leaflet resection in 41 (48%). Ring annuloplasty was also applied in 61 patients (72%). Associated procedures were tricuspid valve annuloplasty in 33 (36%), coronary artery bypass grafting in four, atrial septal defect closure in two, aortic valve repair in one, and resection of abnormal septum in the left atrium in one. RESULTS: There was one hospital death (1%), and one late death (1%). Reopening the chest for bleeding was necessary in six cases (7%). One thromboembolic episode was detected during follow up (0.25%/patient-year). Reoperation for MR was performed in three patients (4%). Actuarial event-free survival rate was 90.0+/-6.4% at eight years. Sinus rhythm was regained in 68 patients (81%), and atrial A-wave was detected in 57 (68%) by pulsed Doppler study. Postoperative left ventricular diastolic and systolic dimensions were significantly (p = 0.001 and p = 0.017) smaller in patients who restored sinus rhythm than in those who did not (48.6+/-4.6 versus 54.6+/-4.7 mm, and 33.0+/-6.0 versus 38.1+/-6.9 mm). CONCLUSION: Combined mitral valve repair for MR and the maze procedure showed satisfactory midterm results. Postoperative sinus rhythm conversion by the maze procedure may reduce left ventricular size, and the incidence of thromboembolic episodes in mitral valve repair.

Adult↗
PubMed2002

Multiple off-pump coronary revascularization with "aorta no-touch " technique using composite and sequential methods.

BACKGROUND: Although off-pump coronary artery bypass grafting (OPCAB) has been widely applied in patients who are considered high risk for cardiopulmonary bypass (CPB), there is still a risk of stroke during the operation because of the ascending aortic partial clamp for proximal anastomosis. In the present study, we report the initial results of an "aorta no-touch " technique using an in-situ graft and composite and sequential grafting methods. METHODS: Between March 2000 and April 2001, 120 patients underwent OPCAB with this technique. The age of patients ranged from 47 to 86 years, with a mean age of 65.7 +/- 8.7 years. On average, 3.12 +/- 0.77 grafts per patient were completed. More than 4 distal anastomoses were performed in 32 patients (27%). As in-situ grafts, 140 internal thoracic arteries (ITAs) and 9 gastroepiploic arteries were used. The radial artery (RA) was used as a Y composite graft in 91 patients, as an I composite graft in 25, and as a K composite graft in 2. Sequential bypass grafting was performed using the RA in 60 patients, the saphenous vein (SV) in 6, the ITA in 4, and the gastroepiploic artery (GEA) in 3. Arterial grafts were used in 92% (345/374) of total bypass grafts. Distal anastomosed sites were 119 left anterior descending arteries (LADs) (32%), 90 posterolateral branches (24%), 64 posterior descending arteries (17%), 49 diagonal branches (13%), 39 obtuse marginal branches (10%), and 13 right coronary arteries (3.5%). RESULTS: There was no operative death or stroke. Early postoperative angiography revealed 95.5% (321/336) graft patency with 100% patency (119/119) of ITA to LAD grafts. Graft patency of the ITAs and RAs (98.5% and 95.9%) were significantly better than that of the GEA (79.0%, p = 0.0064 and p = 0.030) and saphenous vein (82.3%, p = 0.011 and p = 0.048). CONCLUSION: OPCAB performed with the aorta no-touch technique using an in-situ graft and composite and sequential grafting methods provides excellent early clinical results and graft patency.

Aged↗
PubMed2002

Effect of maze procedure in patients with atrial fibrillation undergoing valve replacement.

BACKGROUND AND AIMS OF THE STUDY: The study aim was to elucidate the impact of the maze procedure on late outcome after valve replacement. METHODS: Between 1992 and 2000, 241 patients underwent the maze procedure combined with valve replacement. Patients were allocated to three groups: aortic valve replacement (AVR/maze, n = 16); mitral valve replacement (MVR/maze, n = 148); and combined aortic and mitral valve replacement (DVR/maze, n = 77). RESULTS: Mean follow up was 3.9 +/- 2.3 years. Hospital mortality was 0% in the AVR/maze group, 2.0% (n = 3) in the MVR/maze group, and 3.9% (n = 3) in the DVR/maze group. Elimination of atrial fibrillation (AF) at discharge was achieved in 74.3-75.9% of cases. Freedom from recurrence of AF/atrial flutter was 71.2% in the AVR/maze group, 68.2% in the MVR/maze group, and 64.0% in the DVR/maze group at five-year follow up. By multivariate analysis, risk factors for recurrence of AF/atrial flutter included preoperative enlarged left atrial dimension >70 mm, decreased postoperative fractional shortening <30%, and absence of postoperative left atrial contraction. Freedom from stroke was 93.6% in patients who achieved regular rhythm (normal sinus rhythm or junctional rhythm), and 80.9% in those with recurrence of AF at five years after surgery (p = 0.03). CONCLUSION: The combined maze procedure and valve replacement is safe and effective in selected patients. Restoration of regular rhythm significantly reduced the incidence of late stroke.

Adult↗